Treatment Options

Uterine Artery Embolization

Moderate Value

Uterine fibroids are noncancerous growths that develop in the muscle wall of the uterus. They can vary in size from very tiny to larger than a cantaloupe. A woman can have more than one fibroid in the uterus. Uterine fibroids do not always cause symptoms or require treatment. However, they can cause heavy, prolonged, painful menstrual periods; leg, back, and pelvic pain; painful intercourse; pelvic pressure or heaviness; abdominal swelling; pressure on the bowels leading to constipation and bloating; and pressure on the bladder leading to a constant urge to urinate. Uterine fibroids may prevent a woman from becoming pregnant.

 

Uterine artery embolization (UAE), also called transcatheter UAE, is a nonsurgical treatment that shrinks fibroids. The procedure is done in same day surgery and does not require an overnight stay unless there are complications. An interventional radiologist or x-ray physician performs the procedure. A tube or catheter is inserted into an artery in the upper leg. This tube is threaded through the artery toward the uterus, which is located in the abdomen. After the tube reaches the uterine artery, a dye is injected. The dye helps the physician see the blood vessels with an x-ray machine. Next the physician injects tiny balls the size of sand that are made of plastic or gelatin sponge. These balls block the blood supply to the fibroids causing them to shrink and die. The procedure might be repeated on the other side of the body so the blood supply is blocked in both the right and left uterine arteries.

Things to Consider

  • It is estimated that uterine fibroids occur in as many as half of the women who are of reproductive age
  • An estimated 13,000 to 14,000 uterine artery embolizations are performed each year in the United States
  • African-American women are more likely to develop fibroids and have larger, more numerous fibroids
  • Women who are overweight or obese for their height are at a slightly higher risk for fibroids
  • Women who have given birth appear to be at a lower risk for uterine fibroids
  • The exact cause of uterine fibroids is unclear
  • Since this surgery is usually elective, there is time to consider all treatment options

Results

Moderate Value

Will I live longer if I have this procedure?

Yes, if you are having the procedure as a life-saving measure or for uncontrolled bleeding due to uterine fibroids, you may live longer.

Will the treatment of uterine fibroids improve my quality of life?

Yes, this procedure may relieve serious problems that interfere with normal functions. It might be an option for women who have failed or who cannot use medical therapy, who wish to avoid surgery, or who should not have surgery for a medical reason. This procedure also maintains normal ovary and hormonal function.

Does the treatment of uterine fibroids make my symptoms better?

Yes, available data suggest that UAE offers some relief from the major symptoms of fibroids for about 8 in 10 women undergoing the procedure. However, about 1 in 4 women might need an additional procedure within two to five years. A woman might be able to get pregnant after this procedure although she is at risk for pregnancy-related complications, such as premature delivery, cesarean delivery, or hemorrhage.

Safety

Moderate Value

The Society of Cardiovascular and Interventional Radiology documented 25,000 uterine artery embolization procedures as of the year 2001. Of these, there were four deaths reported as a result of complications.

How safe is this procedure for me?

Before a uterine artery embolization, an adequate evaluation and diagnosis of your problem is necessary. Symptoms like pelvic pain or unusual bleeding may not be related to problems with the uterus. If the uterus is not causing your pain, uterine artery embolization may not relieve the pain. The pain may be due to problems in your digestive, urinary, or skeletal system.

The American College of Obstetricians and Gynecologists' Committee on Gynecologic Practice considers this procedure investigational or relatively contra-indicated in women wishing to have children. The Committee also strongly recommends that women who wish to undergo uterine artery embolization have a thorough evaluation with an obstetrician-gynecologist. This will provide more information for the physician and the radiologists, and will help to ensure that this is the best therapy for you. The physicians will also need to discuss plans for future pregnancies with you.

Minor reported complications:

  • Pain
  • Vaginal discharge, possibly bloody
  • Fatigue
  • Nausea and fever
  • Interruption of menstruation

Major reported complications:

  • Severe pain, which can last for several days or weeks after the procedure
  • Infection
  • Massive uterine bleeding
  • Death of the uterine tissue
  • Premature ovarian failure, resulting in menopausal symptoms
  • If pregnancy occurs after uterine artery embolization, there is a risk that during delivery your baby will come out of the mother feet first or buttocks first, rather than head first. There is also a risk of premature birth, cesarean delivery, or hemorrhage after delivery

Uterine artery embolization is not recommended if any of the following conditions exist:

  • Mild symptoms or lack of symptoms
  • Current pregnancy or plan to become pregnant
  • Endometrial, cervical or ovarian cancer
  • Chronic pelvic infection
  • History of prior pelvic irradiation or renal failure
  • Menstrual symptoms or fibroid growth as a result of postmenopausal hormone replacement therapy

Comparison

Moderate Value

Alternative treatments include:

  • Watching and waiting under the supervision of a physician, to see if the condition improves on its own, since fibroids appear to shrink after menopause
    • Advantages of uterine artery embolization, compared to watching and waiting, include earlier relief of symptoms
    • Disadvantages of uterine artery embolization, compared to watching and waiting, include an invasive procedure with possible complications and recovery from the procedure
  • Hormone therapy
    • Advantages of uterine artery embolization, compared to hormone therapy, include:
      • No hormone therapy required unless ordered by the physician to shrink the fibroid(s) prior to the procedure
      • Fibroids are more likely to achieve permanent shrinkage
    • Disadvantages of uterine artery embolization compared to hormone therapy include:
      • An invasive procedure with possible complications and recovery from the procedure
  • Hysterectomy (Please see the related Medical Technology Rating on Hysterectomy.)
    • Advantages of uterine artery embolization compared to hysterectomy include:
      • No surgical incision or organ removal is done
      • Appears to be safe, costs less
      • Can be performed in an outpatient setting, compared to 24 hour stay for a vaginal hysterectomy or 2 day stay for an abdominal hysterectomy
      • Normal activities can usually be resumed in 2–3 days, compared to 6–8 weeks for hysterectomy
      • Less major complications
  • Disadvantages of uterine artery embolization compared to hysterectomy include:
    • More moderate and minor complications
    • Possible continued bleeding
    • Considered less effective
  • Myomectomy

There are several ways to perform a myomectomy. Surgery with a hysteroscope is one method, with the fibroids removed vaginally. Surgery with a laparoscope is another, with the fibroids removed through a small abdominal incision. Surgery can also be done through a larger abdominal incision.

  • Advantages of uterine artery embolization compared to myomectomy include:
    • No surgical incision
    • Lower complication rate
    • Shorter hospital stay
    • Lower rates of blood transfusions
    • Less risk of intestinal blockage
    • Less risk of fever
    • Less risk of development of scar tissue
    • Less risk of abdominal swelling caused by blood
  • Disadvantages of uterine artery embolization compared to myomectomy include:
    •  increased possibility of needing further invasive treatment (surgery or repeat embolization) in the 3-5 years after the procedure.

Cost

Moderate Value
Procedure Typical charges

Uterine artery embolization

$3,200 to $4,500

Hormone therapy

$50 to $1,700 for a three month supply

Hysterectomy

$5,000 to $6,000

Myomectomy with a hysteroscope

$4,060

Myomectomy with alaparoscope

$4,080

Abdominal myomectomy

$4,500

Watching and waiting is the least expensive means of dealing with uterine fibroids. The only cost may be the co-payment for the office visit.

 

The cost may or may not be covered by your health benefits plan.

Sources

The following are off-site links off-site link :

American College of Radiology. (2013, August). Uterine fibroid embolization (UFE). Retrieved January 9, 2014 from http://radiologyinfo.org/en/pdf/ufe.pdf.

Mayo Clinic. (2013, July). Uterine fibroids. Retrieved January 9, 2014 from http://www.mayoclinic.com/health/uterine-fibroids/DS00078.

National Uterine Fibroids Foundation. About uterine fibroids. Treatments. Retrieved January 9, 2014 from http://www.nuff.org/health_treatments.htm.

Next Review Date

1/23/2015

This document has been classified as public information.

Table of Findings

results:  moderate value

safety:  moderate value

comparison:  moderate value

cost: moderate value


total: moderate value

legend

scale

Page modified:February 5, 2014